Critique of Evidence Based Nursing Research Articles

Read a critique of two evidence based nursing research articles - integrative review and qualitative study. Learn about the appropriateness of methodology, research design, recruitment strategy, data collection, and data analysis.

Running head: EVIDENCE BASED NURSING RESEARCH
Evidence Based Nursing Research
Name of the Student
Name of the University
Author note

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Critique of the first article- integrative review
The CASP tool checklist selected for above article found through CINHAL is
“systematic review checklist” (CASP SR Checklist, 2018) as it there is no specific checklist for
integrative review. The rationale for the choosing this checklist is the “integrative review
methodology” of the above paper which uses studies mainly quantitative and is considered
similar to systematic review (Munn et al., 2014).Therefore, the chosen checklist is justified.
Clearly focused questions
Galiczewski & Shurpin (2017) did not present any clear focused questions. However, it
is evident from the background and the significance section that the research is focused on the
patients with Catheter associated urinary tract infections or CAUTI. The purpose was to focus on
the interventions given to reduce the CAUTI rates and its effectiveness when given in the
intensive care units. However, having the clear focused questions would have enabled readers to
learn the objective of the paper in first stance (Moher et al., 2010).
Right type of papers
According to Zeng et al. (2015), best review would consider studies that address the
clearly focused questions with appropriate study design and evaluation of the interventions. The
author had chosen appropriate research papers for meeting the study objectives (CASP SR
Checklist, 2018). It is evident from clearly defined the inclusion criteria including the study types
considered, which is the primary research articles available in full text on CAUTI patients in ICU
setting. This is sure to provide the valid evidence. Further, the review included studies published
between 1998 and 2014. However, the drawback is the lack of details on the methodology of the

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papers included for integrated review (LoBiondo-Wood & Haber, 2017). It is difficult for the
readers to ensure that the chosen study methodologies were indeed a right type. However, it was
worth continuing with further reading.
Inclusion of relevant studies
It appears that the authors had included important and relevant studies as evident from the
search strategy that includes use of electronic databases such as Cochrane Review, PubMed, the
Cumulative Index of Nursing and Allied Health Literature (CINAHL). These databases are
popular for collection of high quality studies that facilitate evidence-based health care decision-
making (Henry, 2018). The review excluded the non-English language studies, and those
involving in intermittent urinary catheterisation and prophylactic use of antibiotics for the
prevention of CAUTI. There were no clear details if the researcher had followed up the studies
through reference list or had personal contact with the experts to enquire about unpublished
studies, which makes the relevancy one again questionable (Moher et al., 2010).
Assessment of the quality
According to the chosen CASP framework, the review must assess the rigour of the
identified studies as poor rigour may affect the validity of the study (Munn et al., 2014). The
studies included did meet the inclusion criteria and to ensure the reliability and validity the
researcher reads the studies in its entirety. It may be considered a drawback as there were no
details on assessment of quality (CASP SR Checklist, 2018). The studies were not scored for the
quality or determined the k coefficient as recommended by Zeng et al. (2015) for including only
moderate to strong studies. This may be considered the weakness of the article.

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Results combined
The author did consider if the results from study to study was similar and well displayed
the results of all the included study as stated in the CASP framework. The author did present the
well composed tabular chart of studies extracted based on their purpose, design, intervention,
results. Although it was not mentioned earlier in the method section, the author did consider the
studies from different study designs such as meta-analysis, quasi-experimental study, Secondary
data analysis, Randomised control trial, and the sequenced non-randomised studies. It was
observed while critique that the results from the different results were similar. Therefore, the
overall results were categorised into two separate themes. The variation in the results was not
discussed which may be considered a limitation (LoBiondo-Wood & Haber, 2017). However, it
can be considered relevant to combine the results of the review.
Results of the review
The author had clearly presented the overall results of the review. It is easy for the
readers to detect the review’s bottom line results (CASP SR Checklist, 2018). The results
discussed as narrative review due to heterogeneity of the study results. Therefore, it was justified
to make the comparison with two themes that are, “Implementation of a bundle of interventions
to control and prevent CAUTI” and “implementation of a single intervention to control and
prevent CAUTI” in catheterised patients. The reviewer evaluated the outcome of these
interventions on patient outcomes. There was no need to measure the numerical appropriateness
of the results since there was no meta-analysis. Therefore, the descriptive presentation of themes
was appropriate. Due to the same reason, there is no relative risk identified or odd ratio
calculated (Zeng et al., 2015; LoBiondo-Wood & Haber, 2017). Thus, the overall results are
justified to address the research question as it was found that the CAUTI infection rates could be

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decreased by discontinuance of urinary catheters in less than seven days or daily review of
catheter.
Precision of results
The precision of the results are doubtful as the confidence intervals are not reported in
the integrative reviews. However, some of the study results did present the odd results and
evaluated the interventions (Henry, 2018). The overall results may be considered reliable and
give valid evidence about the interventions to reduce CAUTI infection rates (Durant, 2017).
Application of results locally
The application of the results of the review was critiqued for its application locally. It
was found that the interventions cannot be provided in another setting other than ICU although
the population would be same as the review. The results of the review considered the
intervention for the CAUTI patients and the outcomes when given in ICU setting. Therefore, it
can be applied in ICU and not in long-term nursing units (Durant, 2017; Henry, 2018).
Moreover, all the interventions are not integrated in the review that may minimise the risk of
CAUTI in catheterised patients. The patient covered by the review may be different to my
population to cause concern. The local setting also may be different from the review.
Outcomes
All the important outcomes have been considered but are mostly related to the patient
and health care professional’s outcome. It can be applied, which is indicating the need for
practice implications. Overall the results have given insufficient evidence. The nature of the
interventions is inconclusive. There is a need to consider the interventions for CAUTI infections

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in different hospital settings and on different population of patients (Durant, 2017). It will help
develop multidirectional approach to treat patients based on evidence-based interventions.
Benefits, harms and cost
It appears that the benefits are more than harm if the interventions are given for similar
population in similar setting. However, it may lead to cost increase as different interventions may
be applicable in different setting for different population. Thus, there is a need of
multidimensional approach, in which these interventions can be incorporated. In conclusion, the
benefits may not worth the harm and cost as the evidence is insufficient (LoBiondo-Wood &
Haber, 2017).
Critique of the Second article- qualitative study
Qualitative studies help identify useful themes through interviews and verbatim quotes.
The CASP qualitative checklist is used for this article as the methodology of the above article is
qualitative interview. It is useful to critique the article (CASP-Qualitative-Checklist, 2018).
Clear statement of the Aims
Prinjha et al. (2016) had presented the clear statement of research aims while detailing
the need of research supported with existing literature in this area. The goal of the research was
to explore the information needs of the catheterised patients (indwelling urinary catheter) and
outcome of the inadequate information and interventions to address the needs. The research aims
is justified as there is lack of appropriate methods to meet the needs of the information needs of
long-term indwelling catheter users. Therefore, the research aims are relevant.

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Appropriateness of qualitative methodology
According to CASP-Qualitative-Checklist (2018) this method is appropriate to interpret
or illuminate the actions or subjective experiences of research participants. The interview was
collected using the narrative approach. Thus, the methodology is appropriate for addressing the
research goal. It is because the interview will help interpret the subjective experiences and
emotions of the research participants who are catheterised when they lacked adequate
information.
Appropriateness of the research design
The author had selected a qualitative interpretative research design with the thematic
analysis. It is appropriate as the qualitative research uses participant’s responses instead of
statistics to gather data around the topic. It is the essence of the qualitative research. It looks at
social phenomena to interpret what people do and rationale (Hannes, 2011). Thus, the research
design is appropriate for addressing the research goals. The author had discussed that the method
of interview will help researcher collect the oral history of the participants’ priorities, meanings,
and concerns. It is appropriate to meet the research aims and may be considered the strength of
the study.
Recruitment strategy
To ensure that the recruitment strategy is appropriate to meet the research aims, the
researcher must explain the how the participants were recruited (Hannes, 2011). The author had
explicitly presented the selection criteria of the patient. Adult men and women living in the UK
with indwelling urinary catheter, more than three months were selected. The researcher justified
taking diverse participants with collection of broad range of patient’s experiences. In addition, it

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was also succinctly mentioned that the potential participants were recruited by through specialist
nurses, expert advisory panel members, urologists, support organizations and through personal
contact. Potential participants with interest in narrating their experiences where chosen. Thus,
there were the most appropriate to gather desired data (CASP-Qualitative-Checklist, 2018).
However, the drawback is no highlights on people refusing to participate in the study.
Data collection
Data must be collected from the participants in the way that should address the research
issue (LoBiondo-Wood & Haber, 2014). The setting for interview that is patient’s home is
justified for in-depth interview as the patients would be comfortable in their home than in any
hospital setting to freely narrate their issues. Thus, the patients may be more willing to deliver
authentic personal information (CASP-Qualitative-Checklist, 2018). The interviewers are
anthropologists and medical sociologists, so, there may not be any interviewer effect or bias
(Hannes, Lockwood & Pearson, 2010). Further, the researcher seems to have collected reliable
information from the participants by using topic guide, as mentioned by Ritchie et al. (2013).
The researcher has explicitly discussed this section stating that interview lasted for two hours and
used videos and or audio recorders for transcription and analysis (Prinjha et al. 2016). The
saturation point was collection of desired and diverse range of experiences. Thus, a valid data
may be obtained for devising appropriate interventions. Each step of data collection was
conducted as per evidence-based protocol and also predetermined questions. Senior researchers
were involved in study along with project advisory panel (LoBiondo-Wood & Haber, 2014).

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Relationship between researcher and participants
There must be adequate consideration of the relationship between the participants and
the researchers as per the CASP framework (CASP-Qualitative-Checklist, 2018). Before the
interview, the researcher successfully established a strong rapport with the participants to help
them develop clarity about the usage of the information collected. This indicates the role played
by him in data collection. However, there was no data on the bias and influence. Lack of succinct
details on responding to the interview events and changes on research design decreases the
reliability of the results (Hannes, 2011).
Have ethical issues been taken into consideration?
To ensure the credibility of the ethical research issues must be considered Ritchie et al.
(2013). The author took informed consent from all the participants included in the study. Prior to
interview, respondents were informed about the research purpose and interview process. Also,
the research was approved by the Berkshire Research Ethics Committee. So there is no issues
related to the welfare of the participants, however, not justified by the researchers. Though the
author directly does not explain if the confidentiality was mentioned, it can be assumed to have
so because the author stated that “Pseudonyms are used in reporting the results” (Prinjha et al.,
2016). However, there should have been succinct details confidentiality or handling of
participants after the study to ensure reliability and validity (Hannes, 2011).
Data analysis
A rigorous data analysis is the hallmark of the reliability and validity of the results
(Hannes, 2011). The data was sufficient enough to support the findings. The research lacked the
criticism of the own role in the analysis of the data. Qualitative research mainly uses thematic

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analysis and coding to identify the main themes (Bradshaw & Stratford, 2010) and the same was
followed in this article. The grounded theory approach underpinned the data collection approach
as mentioned by Thomas & Magilvy (2011). The data was well analysed as evident from well-
crafted themes. The author had also succinctly mentioned about the rigour of the study due to
methods used of Oxford Health Experiences Research Group, and National Health Service
(NHS) Information Standard. It ensures of credibility, validity and reliability is ensured by the
data collection process (Thomas & Magilvy, 2011). However, it should have highlighted any
contradictory data.
Findings
As per CASP framework selected for this article, the paper should have clear statement of
findings (Bradshaw & Stratford, 2010). As per the findings, the participants were in dire need of
the technical information about catheter to deal with physical problems such as infection,
blockage, and leaking. The findings were clear and explicit as there was also well-supported
discussion flowing flawlessly. Presence of more than one analyst ensures respondent validation.
The discussion was discussed as per the original research question.
Value of research
A research may be highly valuable if the results could be applied locally (CASP-
Qualitative-Checklist, 2018). However, in this case, the results may not be applicable; as the
participants may have forgotten exactly what information they have needed as some were
catheterised 20 years ago. Yet, the results are valuable as they can be used by the health care
professionals to impart appropriate knowledge to the patients. Nurses can use this data to offer
more support to the patients in future (Koch et al., 2012). The study has contributed to practice

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and policy. The research may be generalised as a large sample was considered from diverse
backgrounds. I feel there should have been more discussion on transferability.
Comment on author and credibility
In the first paper the first author Galiczewski, and the second author both works at “Stony
Brook University School of Nursing, United States”, and the first author is also associated with
the “Stony Brook University School of Nursing, United States”. Lack of author’s qualifications
makes the author’s credibility questionable. This paper is the published by Elsevier, in Intensive
and Critical Care Nursing ( that has RG impact factor of 1.11, which is not very high). The five
year impact factor of Elsevier is 3.279 which is less than standard score of 10. However, it is
popular for the evidenced based information. The SJR that is rank indicator of the journal is
0.564 bt H index is 44 > than standard 20-27 and is considered to give reliable information in
area of nursing (Scimagojr.com, 2018).
In the second paper, the first author Suman Prinjha is the senior researcher in university
of Oxford, and holds Msc and PhD degrees. The second author is the Joanne Mangnall, is an RN
with Msc degree and works as “Independent Prescriber/Clinical Nurse Specialist” and Clinical
Lead at “Rotherham Centralised Product Prescribing Service, UK”. As both authors hold
degrees required for conducting research, the credibility is ensured. Moreover, the paper is
published, Journal of Advanced Nursing, which has impact facto of 1.998 and the ranking as per
ISI JCR is 2016:13/116. This is not a very highly credible paper in terms of 1.998 tor of as it is
too less in terms of journals having impact of 12 (Cao et al., 2018).

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